Myxedema is an extreme degree of hypothyroidism, which develops in the overwhelming majority of cases in adult patients and adolescents suffering from hypothyroidism (relative or absolute deficiency of thyroid hormones). A characteristic manifestation of this serious disease, detected in all patients, is the development of mixed edema of the skin and subcutaneous fatty tissue, so dense in structure that even strong pressure does not leave pits on the surface of the body.    

REASONS AND MECHANISM OF DEVELOPMENT OF MIXEDEM 

This condition develops if the body has a deficiency in the production or effect of thyroid hormones (thyroxine and triiodothyronine) – in 95% of cases, myxedema develops against the background of primary hypothyroidism. Nevertheless, the severity of signs of damage to organs and body systems in different patients will manifest in their own way – that is why, if you suspect myxedema, a comprehensive examination of the body is necessary .     

Damage to the nervous system and higher nervous activity

In the event that a deficiency of thyroid hormones occurs in the body, the degree of damage to the nervous system largely depends on the patient’s age. The characteristic signs of the disease are: 

• hypothyroid encephalopathy – manifested by a decrease in intelligence and mental activity, general lethargy of the patient, slowness and drowsiness, which persist even after rest, slowing down of thinking and the rate of speech, memory impairment, a tendency to depression, a reduced level of reflexes; 
• cerebellar ataxia – manifested by movement disorders; 
• common paresthesias;
• a decrease in the tone of the sympathetic-adrenal part of the autonomic nervous system – manifested by a sharp decrease in sweating, a decrease in the tone of the digestive tract (digestive disorders, chronic constipation).

A person suffering from myxedema practically loses the ability to perceive and assimilate new information, is constantly in a depressed, oppressed state.

SYMPTOMS OF THE CARDIOVASCULAR SYSTEM IN THE MIXEDEM

Typical signs of damage to the circulatory system in case of insufficient thyroid hormones are:

• a pronounced slowdown in the rhythm of heart contractions, a decrease in the fraction of cardiac output and the development of progressive heart failure;
• an increase in the size of the heart due to a decrease in the contractile activity of the myocardium against the background of progressive degenerative changes in the muscle of the heart and the accumulation of fluid in the pericardium (pericardial sac);
• the appearance of severe pain in the region of the heart – these signs occur against the background of progressive insufficiency of the coronary circulation and metabolic disorders in the myocardium;
• slowing down blood flow in all tissues and organs, including at the capillary level.

Patients with myxedema may show signs of severe damage to the heart and blood vessels, which remain resistant to the prescribed standard therapy and even progress with the treatment.

SIGNS OF DESTROYING THE DIGESTIVE TRACT AT MIXEDEM

The characteristic signs of damage to the digestive tract with myxedema are:

• a sharp decrease in appetite;
• nausea and vomiting;
• progressive disturbance of digestive processes in the intestine, which occurs against the background of hypoacid gastritis, hypokinesia and hypotension of the intestine and biliary tract – patients may experience disorders of membrane and cavity digestion, constipation, which often culminate in the development of intestinal obstruction.

Despite the fact that patients suffer from lack of appetite, they may become overweight – even a careful correction of the diet and an increase in the level of physical activity do not help to normalize the patient’s condition.

In addition, patients experience impaired renal excretory function – the causes of this condition are both a decrease in the speed of blood flow in the kidneys and a sharp decrease in the concentration of sodium in the blood serum. It is possible to develop an ascending urinary tract infection – urethritis, chronic cystitis, inflammation of the ureters and renal pelvis are provoked by hypokinesia and hypotonia of smooth muscles of the excretory system.

SYMPTOMS OF MIXEDEM

A close examination of a patient suffering from primary or secondary severe thyroid hormone deficiency reveals signs of damage to almost all systems of the patient’s body. The main diagnostic criteria are:

• pronounced edema of the skin and subcutaneous fatty tissue – as a result of this, the patient’s face becomes like a mask, puffiness and roughness of certain facial features appear, dense swelling under the eyes is formed, which does not disappear even after a long rest;
• fragility and thinning of hair, as well as their massive loss, the appearance of fragility and layering of the nail plates – the cause of damage to the accessory apparatus of the skin is dystrophic changes in the fiber against the background of diffuse mucous edema;  
• a change in the timbre of the voice and the appearance of stuttering speech – the causes of this condition are swelling of the vocal cords and tongue;   
• common symptoms of the disease are constant chilliness, pain in the heart, an expression of a decrease in the tone of the body, drowsiness, lethargy.

In addition, sick patients may complain of joint pain, muscle weakness, arthralgia, progressive arthrosis, signs of polyserositis (inflammatory lesions of the serous membranes of the peritoneum, pleura and pericardium) may appear.

DIAGNOSTICS OF MIXEDEM

To establish the diagnosis of myxedema, it is important not only to detect the symptoms of the disease, but also to confirm them with a sharp decrease in the level of bound and free thyroid hormones (thyroxine and triiodothyronine), thyroid stimulating hormone of the pituitary gland. In addition, it is imperative to conduct an ultrasound examination of the anterior surface of the neck to clarify the structure of the thyroid gland and aspiration biopsy of the thyroid gland for cytological analysis of the contents obtained.  

TREATMENT OF MIXEDEMA

The only method of treating myxedema is the introduction of drugs containing thyroid hormones from the outside – the choice of the drug and the calculation of the dose are always carried out individually, depending on the patient’s response to the therapy. The prescribed drug is taken in the morning, once a day. In the vast majority of cases, hormone replacement therapy should be carried out for life.  

At the same time, it may be necessary to prescribe products rich in iodine (seafood – seaweed, fish, nuts), salting food with iodized salt after cooking, prescribing iodine-containing preparations .